Rosacea

By Dr. Loretta Lanphier, ND, CN, HHP, CH

If you consistently struggle with a red face and pimples, consider the possibility that you may have more than a persistent case of acne, especially if you have outgrown your teen years and are a thirty or forty something. You may be suffering from a condition called rosacea, which is a quite common skin disorder that is sometimes confused with acne.

What is Rosacea?

Rosacea is a progressive inflammatory skin disorder that causes facial redness and blemishes. It used to be mistakenly referred to as “acne rosacea” or “adult acne” because of the similarity of some of its symptoms to acne. However, rosacea and acne are two distinct and separate conditions. The major difference between the two is that acne exhibits blemishes called whiteheads and blackheads, while rosacea does not. Some have likened the appearance of rosacea to sunburn.

The characteristics of rosacea include a red face, flushed skin, pimples, and the appearance of tiny, spider-like veins on the skin (telangiectasias). Most symptoms appear on the face, but some patients experience outbreaks on their back, scalp, arms, legs, and neck. In the advanced stages of rosacea, the face may swell and the nose may take on a bulbous appearance (rhinophyma).

Rosacea is a chronic condition most often found in fair skinned adults between the ages of 30-60. It is thought to affect more than 14 million Americans. Women have a three times higher incidence of rosacea than men, but men’s symptoms tend to be more intense and more highly visible. In most individuals, rosacea is cyclic in nature, meaning that it can flare up for weeks or months at a time, and then disappear until the next episode.

What Are the Symptoms of Rosacea?

The typical signs of rosacea in the majority of patients are as follows:

  • Red areas on the face
  • Tendency to easily blush or get flushed.
  • Small red pimples or pustules on the nose, forehead, chin, and cheeks. These are not the same as the whiteheads or blackheads that are associated with acne.
  • The appearance of spider-like blood vessels on the nose and cheeks (telangiectasias).
  • In the advanced stages, the nose appears red and bulbous (rhinophyma).
  • Approximately 50% of rosacea patients experience symptoms related to their eyes. This is called “ocular rosacea,” and is often the first sign of rosacea in some, preceding the other symptoms. Telangiectasia (spiderous veins) may develop around the edges of the eyelids, resulting in chronic inflammation (conjunctivitis). Small bumps known as chalazions may also appear. These symptoms do not usually impair vision. However, in some cases the transparent covering over the lens of the eye, the cornea, can be involved. If this occurs, vision may be affected.

Rosacea commonly develops in phases:

  • Pre-rosacea:  In the early stages of the disorder, rosacea may show itself simply as a tendency to blush easily. From there it may progress to a consistent redness of the nose and central part of the face. This is due to the dilation of blood vessels closest to the surface of the skin.
  • Vascular rosacea:  As rosacea worsens, small blood vessels on the nose and cheeks may begin to swell and get inflamed (telangiectasias) and the skin becomes super sensitive to any irritants. Dandruff and unusually oily skin appear in many folks as well.
  • Inflammatory rosacea:  At this point, small red pimples or pustules may show up on the nose, forehead, cheeks, and chin.
  • Rhinophyma:  Sometimes, in severe cases of rosacea, the sebaceous glands (oil glands of the skin) of the nose and/or cheeks become enlarged, causing tissue to build up. The nose takes on a bulb-like appearance. This symptom is much more common in men than in women, although it is not known why. Rhinophyma typically progresses slowly over a period of years.

What Causes Rosacea?
The cause of rosacea is not known for certain, but there are several theories that provide clues to the puzzle:

  • Bacterial:  Antibiotics are commonly prescribed for treating rosacea, not because they are effective against bacteria, but because they have an anti-inflammatory affect. Since antibiotics seem to be helpful, this has caused some to speculate that bacterial infection may play a role in rosacea. Beyond that, recent research has pointed to a bacterium that is often responsible for causing stomach ulcers called heliobacter pylori. This bug causes chronic infections in the gastrointestinal tract, and some studies have linked it to rosacea as well. It is thought that the imbalance of the digestive system caused by heliobacter pylori is somehow a trigger for rosacea, but the process is not well understood.
  • Hypochlorhydria:  Here is another link to digestive function. Hypochlorhydria is a condition that results in reduced production of gastric acid, commonly known as digestive juices. It is thought that a reduction of digestive juices may contribute to an increase of toxins in the body, which in turn triggers rosacea. Many people with hypochlorhydria also suffer from brittle fingernails and hair, and constipation. A decline in gastric acid levels is normal for many people as they age, but it may also be brought on by emotional issues such as stress, anxiety, and depression.  The solution for hypochlorhydria, and the resulting rosacea symptoms, is supplementation with hydrochloric acid tablets in order to increase stomach acid. Use of a probiotic such as acidophilus along with the hydrochloric acidis also recommended.  Interestingly enough, hydrochloric acid supplementation is also used as an alternative therapy for fighting acid reflux. Despite what the antacid commercials tell you, acid reflux is often caused by too little stomach acid, and not by too much. I’m a little bit off the point here, but I couldn’t resist throwing this info into the mix.
  • Food Allergies:  Studies have shown that when certain foods are eliminated from the diets of rosacea patients, their symptoms improve or in some cases disappear altogether. A good place to start investigating what might be triggering your own rosacea would be to try avoiding any foods you may have been allergic to as a child. Many folks have discovered that their consumption of yeast contributes to their rosacea. While on the subject of diet, it is a good idea to avoid any food or beverage that causes your blood vessels to dilate. Some examples might be alcohol, coffee, tea, caffeinated sodas, or overly spicy foods. You might look forward to Uncle Joe’s nitro chili every year at the family reunion, but for the sake of your rosacea, you’d be better off staying away from it.
  • Parasites:  There is a tiny mite called demodex folliculorum that has been found in the skin areas of patients affected by rosacea. It is thought that these critters may take up residence in the hair follicles, and clog up the sebaceous glands. They do not technically cause rosacea, but they may play a role in aggravating the condition.
  • Sun-damaged skin:  Many rosacea patients seem to have allowed themselves to be over exposed to the sun. This common plight has led some to believe that this may be a contributing factor in rosacea.
  • Alcohol does not cause rosacea:  One of the slang terms for rosacea used to be “Brandy Nose,” based on the misconception that drinking excessive amounts of alcohol causes rosacea. Alcohol may cause the face to be flushed and definitely can make an existing case of rosacea worse, but it does not cause it. You can be a teetotaler and still suffer from rosacea.

Anything that causes  blood to flow to the surface of your skin can contribute to rosacea:

  • Strenuous exercise.
  • Hot baths, showers, saunas, or whirlpools.
  • Hot beverages.
  • Extreme temperatures, both hot and cold.
  • Too much sunlight.
  • Stressful situations.
  • Anger or embarrassment.
  • Certain medications, such as corticosteroids and some blood pressure medicines (they dilate the blood vessels).
  • Some over-the–counter skin care products which contain abrasive chemicals such as acids and alcohol.

What Treatments Are Available for Rosacea?

The best natural recommendations I can give for treating rosacea are those mentioned above: use of hydrochloric acid tablets, a probiotic, determine if you have any food allergies that may be contributing to your rosacea, and avoid any irritants such as skin cleansers or soaps that may aggravate your rosacea. Use common sense about being in the sun. Eat a healthy, whole-foods diet, staying away from excessive spiciness. In addition, some folks have seen improvement in their rosacea from natural B12 supplementation, and gentle facial massage. These common sense tips can make a significant difference in most cases of rosacea, and may keep the condition from developing in the first place.

The alternative is to go with what mainstream medical is pushing, and frankly, they offer some pretty scary options.

  • Antibiotics:  Long-term use (sometimes ongoing) of oral antibiotics such as tetracycline is one of the most common recommendations from doctors. I don’t even like to use a ten-day course of antibiotics, much less long-term. The thought of taking these drugs for months or even years is ludicrous. The overuse of antibiotics has led to many strains of bacteria that develop immunity to them. Not only that, but they cause many other side effects which can range from relatively minor to extremely serious. Tetracycline has been identified with: increased yeast infections, such as candida, nausea, vomiting, diarrhea, headaches, and visual problems. It is also linked to more serious conditions such as systematic lupus erythematosus (a chronic inflammatory disease), enterocolitis, and pancreatitis. Surely there must be a better way to treat illness than to expose the body to such risks!
  • Isotretinoin:  This drug is a powerful and dangerous medication that contains a very harmful form of synthetic Vitamin A. Even the FDA puts a short leash on this one. In order for any woman of child bearing age to use isotretinoin, she must agree to a strict federally mandated monitoring program. The drug has been clearly linked to severe birth defects in children whose mother has been using it. It is very dangerous for a woman to be pregnant or become pregnant while taking isotretinoin. If it was me, I think I would rather live with a relatively harmless skin disorder than to expose myself or my child to such risks. But the list of possible harmful side effects goes far beyond birth defects. It includes:  hearing loss, hair loss, liver disease, mood swings, muscle pain, arthritis, visual disturbances, and an increased risk of teen suicide. If your health provider is not informed enough to avoid prescribing tetracycline in combination with isotretinoin, you can add intra-cranial hypertension to the list. It seems like the madness never ends.

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